Table 5 Application of methods per patient’ and nurse’ determinants
Determinant | Methods | Applications | How context and parameters were taken into account |
|---|---|---|---|
Patients’ knowledge | Provide information using different methods about undernutrition and nutritionf, g, i, j | General and tailored information during the consults with advice and leaflets | Context: Consult during pre-operative evaluation and follow-up Parameters: patients received general information and advice orally by the nurse, received general leaflets. Questions were addressed and discussed. |
Increase memory and understandinga | Counselling during the consult and follow-up | ||
Patients’ awareness | Provide information about risks and consequencesa, f, g, i, j and encourage on desired behaviourh | General and tailored information during the consults with advice and leaflets | Context: Consult during pre-operative evaluation and follow-up Parameters: To tailor information, individual causes for undernutrition were determined and related advice was given; evaluation during follow-up to encourage the patient |
Tailor advices to the individual cause (s) of undernutritionh | Counselling during the consult and follow-up for encouragement and the nutritional care plan | ||
Self-monitor nutritional intakeh | Evaluation of the intake as recorded in a food diary during follow-up | Context: Consult during pre-operative evaluation and follow-up Parameters: by monitoring personal nutritional intake patients become aware | |
Patients’ skills | Instruct how to monitor nutritional intakea, b, d | Instruction of recording intake using a food diary during the consult | Context: Consult during pre-operative evaluation and follow-up Parameters: a food diary was supplied and patients were instructed to monitor intake. |
Instruct innovation of personal eating patterna, e, f | Advice during the consult and evaluation during follow-up | ||
Plan social supporth | Follow-up by nurse or dietician | Context: Telephone follow-up Parameters: records of food intake were discussed and questions were addressed | |
Nurses’ knowledge | Refresh knowledgec and provide information about behaviour-health linka, about undernutrition, its causes and consequencesWensingg, about nutrition during surgeryi, j, and about behaviour change12 | Training (given by dietician and nursing researcher) in which information is provided | Context: Training in small groups. Parameter: Schematic representations; an overview of current knowledge, adjusted to the knowledge level shown in individual interviews. |
Model or demonstrate the behaviour by modelling c Provide instruction by active learning, advance organisers, and cooperative learningb Educational meetings by advance organisers, implementation intentions, and persuasive communicationc, d, e | Training in which information is shown of the several steps of the intervention. Cases are discussed, and nurses did some role playing to exercise. Step-by-step written explanation of how the intervention must be carried out, given to nurses. | Context: Training in small groups. Parameters: a role play of the intervention during the training as an example and comparison with their own behaviour. Schematically displaying the intervention in the step-by-step written information. Discussing the ONNIa during follow up meetings (once a week) to encourage nurses toward the adoption of the intervention. | |
Nurses’ self-efficacy and skills | Provide general encouragement, providing feedback on performance by mobilizing social support, consciousness raising and feedbacka, b, c | Nurses give feedback to the researcher during role play, and the researcher visits the outpatient clinic to discuss feedback. | Context: the nursing teams at the outpatient clinics included are relatively small and therefore easily approachable, and visiting the outpatient clinic is a low-key approach in talking to the nurses. Parameters: Specific feedback is given, nurses are given the opportunity to talk about the use of the ONNI, and their behaviour, encouraged by the researcher. |
Prompt barrier identification and reviewing practice and feedback by planning coping responses and discussiona | Individual interviews in which nurses are invited to think about barriers and facilitators around the nursing nutrition intervention, and weekly meetings in which the use of the intervention is discussed. | Context: All nurses of the outpatient clinic were interviewed. Usual care was observed, in both hospitals. Parameters: While designing the intervention, potential barriers, based on observations and interviews, were identified and the expert team discussed on what was needed to overcome these barriers. | |
Provide information about colleagues’ approval by modelling and information about others’ approvalc Stimulate discussion between nurses by mobilizing social support and guided practicea, c | Follow-up meetings with nurses in the intervention groups (answering questions, discussing experiences) | Context: Weekly follow-up meetings with nurses Parameters: discuss cases, what went well and what could be improved; intervention performance with positive aspects and challenges. | |
Nurses’ attitude | Provide information about patients’ perspective by shifting perspective e Provide overview of the nursing role in (under) nutritiona, h Validate and empower on desired behaviourc Visits to the outpatient clinics by researchersa, b, c, d | Training and follow-up meetings in which quotes from patients are discussed. | Context: Training in small groups and weekly follow-up meetings with nurses. Parameters: Quotes from observations of usual care and the nursing nutrition intervention were discussed to encourage nurses to take the perspective of the patient to increase the adoption. |